An anal fissure is a small split or tear in the thin moist tissue (mucosa) lining the lower rectum (anus).
Causes, incidence, and risk factors
Anal fissures are extremely common in young infants but may occur at any age. Studies suggest 80% of infants will have had an anal fissure by the end of the first year. The rate of anal fissures decreases rapidly with age. Fissures are much less common among school-aged children than infants.
In adults, fissures may be caused by constipation, the passing of large, hard stools, or by prolonged diarrhea. In older adults, anal fissures may be caused by decreased blood flow to the area.
Anal fissures are also common in women after childbirth and persons with Crohn's disease.
Anal fissures may cause painful bowel movements and bleeding. There may be blood on the outside of the stool or on the toilet tissue (or baby wipes) following a bowel movement.
Other symptoms may include:
A crack in the skin that can be seen when the area is stretched slightly (the fissure is almost always in the middle)
Signs and tests
The health care provider will perform a rectal exam and look at a sample of the rectal (anal) tissue.
Most fissures heal on their own and do not require treatment, aside from good diaper hygiene in babies.
However, some fissures may require treatment. The following home care methods usually heal most anal fissures.
Cleansing more gently
Diet changes -- eating more bulk, substances that absorb water while in the intestinal tract
Muscle relaxants applied to the skin
Numbing cream, if pain interferes with normal bowel movement
Todd Eisner, MD, Private practice specializing in Gastroenterology, Boca Raton, FL. Clinical Instructor, Florida Atlantic University School of Medicine. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.